电针联合音乐疗法对轻中度阿尔茨海默病患者认知功能和日常生活活动能力的影响

赵玉晓 戈利生 赵丽莉 张劲松 杨涛 李广志

摘要 目的：研究電针联合音乐疗法对轻中度阿尔茨海默病患者认知功能和日常生活活动能力的影响。方法：选取2015年1月至2017年8月张家口市第一医院收治的轻、中度阿尔茨海默症患者120例为研究对象，按照随机数字表法随机分为对照组和观察组，每组60例。比较患者治疗前后临床治疗有效率、认知功能、生活自理能力、行为和精神症状及生命质量，并通过胆碱能系统和单胺系统评价患者神经递质改善情况。结果：治疗后，对照组和观察组的治疗有效率分别为81.67%和91.67%。治疗后，2组患者MMSE、MoCA、ADL、BEHAVE-AD和SF-36评分均显著高于治疗前，差异有统计学意义（P<0.05）;且观察组患者上述指标均显著高于对照组，差异有统计学意义（P<0.05）。治疗后，2组患者的乙酰胆碱水平、胆碱乙酰化酶活性、去甲肾上腺素水平、5-羟色胺水平和多巴胺受体均高于治疗前，差异有统计学意义（P<0.05）;且观察组的上述指标均显著高于对照组，差异有统计学意义（P<0.05）。结论：电针联合音乐疗法治疗轻中度阿尔茨海默病，可有效地改善患者的认知能力和日常生活活动能力。

关键词 电针;音乐疗法;阿尔茨海默症;认知功能;日常生活活动能力;生命质量;胆碱能系统;单胺系统;神经递质

Abstract Objective：To study the effects of electroacupuncture combined with music therapy on cognitive function and activities of daily living （ADL） in patients with mild and moderate Alzheimer′s disease.Methods：A total of 120 patients with mild and moderate Alzheimer′s disease treated in the First Hospital of Zhangjiakou from January 2015 to August 2017 were divided into a control group and an observation group according to the random number table method，with 60 cases each group.The total clinical effective rate，cognitive function，self-care ability，behavioral and mental symptoms and life quality before and after treatment were compared，and the improvement of neurotransmitters of patients was evaluated by cholinergic system and monoamine system.Results：Before treatment，the difference was not statistically significant in general material between the 2 groups （P>0.05）.After treatment，the total effective rate of the control group and the observation group was 81.67% and 91.67% respectively.After treatment，the scores of MMSE，MoCA，ADL，BEHAVE-AD and SF-36 in the 2 groups were significantly higher than those before treatment （P<0.05），and the above-mentioned indexes in the observation group were significantly higher than those in the control group （P<0.05）.After treatment，the contents of acetylcholine，choline acetylase，norepinephrine，5-hydroxytryptamine and dopamine receptor in the 2 groups were significantly higher than those before treatment （P<0.05）.The above-mentioned indexes in the observation group were significantly higher than those in the control group （P<0.05）.Conclusion：Electroacupuncture combined with music therapy in the treatment of mild and moderate Alzheimer′s disease could effectively improve patients′ cognitive function and activities of daily life，which is worthy of clinical application.

Keywords Acusector; Music therapy; Alzheimer′s disease （AD）; Cognitive function; Activities of daily living; Life quality; Cholinergic system; Monoamine system; Neurotransmitter

中图分类号：R242;R749文献标识码：Adoi：10.3969/j.issn.1673-7202.2020.13.029

阿尔茨海默病（Alzheimer′s Disease，AD）又称老年痴呆症，是一种进行性神经退行性疾病，临床特征为认知、功能和行为改变，其特征还包括组织病理学、分子和生化异常，如细胞丢失、神经元纤维缠结在细胞内堆积、营养不良的轴突、淀粉样蛋白-β沉积、能量代谢紊乱、线粒体功能障碍、慢性氧化应激和DNA损伤[1]。其中神经元纤维缠结在细胞内的堆积在空间和时间上都与神经元变性和认知症状密切相关[2]。目前，AD的发病机制目前尚未完全明确，也没有特效的药物治疗此病。近年来，随着我国人口老龄化的加快，AD的发病率呈直线上升趋势，据统计，我国5%的老年人患有阿尔茨海默症，而且85岁以上的老年人AD的患病率已到达20%[3]，目前全球有580万人患有AD，预计到2050年将增加到1 400万[4]。A……